Chronic graft-versus-host disease (cGVHD) following allogeneic hematopoietic cell transplant (HCT) has been linked to paediatric cancer survivors developing nonmalignant late effects, according to a recent study.
Up to one quarter of children who undergo hematopoietic cell transplantation (HCT) develop cGVHD. The research, published in Transplantation and Cellular Therapy, discovered that cGVHD is a “major cause of late morbidity and poor quality of life among long-term survivors of paediatric HCT.”
They added: “Late effects (LEs) of HCT are well documented in this population, and cGVHD has been identified as a risk factor for subsequent neoplasms (SNs) and several nonmalignant LEs (NM-LEs); however, the reported correlation between cGVHD and LEs varies among studies.”
However, the study did not find a link between cGVHD following HCT and SNs. Instead, SNs were found to be associated with myeloablative total body irradiation.
The study analysed data collected from the Center for International Blood and Marrow Transplant Research. The data came from 1,260 patients who had their first HCT for a hematologic malignancy between 2000 and 2010 and had lived disease-free for at least two years following HTC.
First malignant and nonmalignant late effects in the paediatric cancer patients were evaluated. The researchers based their evaluation on the outcomes for participants with and without cGVHD and analysed first late effects risk factors.
Research findings
39 per cent of the patients had a two-year incidence of cGVHD. Results were used to estimate that the 10-year cumulative incidence of late effects was 43 per cent for survivors with cGVHD and 32 per cent for survivors with no cGVHD.
The researchers stated: “The development of cGVHD by 2 years post-HCT was independently associated with any LE (hazard ratio [HR], 1.38; 95% CI, 1.13 to 1.68; P = .001) and NM-LE (HR, 1.37; 95% CI, 1.10 to 1.70; P = .006), but not SN (HR, 1.30; 95% CI, .73 to 2.31; P = .38).
“cGVHD-related factors linked with the development of an NM-LE included having extensive grade cGVHD (HR, 1.60; 95% CI, 1.23 to 2.08; P = .0005), severe cGVHD (HR, 2.25; 95% CI, 1.60 to 3.17; P < .0001), interrupted onset type (HR, 1.57; 95% CI, 1.21 to 2.05; P = .0008), and both mucocutaneous and visceral organ involvement (HR, 1.59; 95% CI, 1.24 to 2.03; P = .0002).”
They concluded: “Future research should continue upon this work and re-evaluate the impact of cGVHD on late effects using the 2014 National Institutes of Health consensus criteria for cGVHD.”
